Provider Demographics
NPI:1487485413
Name:GORDON CENTER FOR GENERAL AND ADVANCED DENISTRY, LLC
Entity type:Organization
Organization Name:GORDON CENTER FOR GENERAL AND ADVANCED DENISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-258-1998
Mailing Address - Street 1:656 QUINCE ORCHARD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1423
Mailing Address - Country:US
Mailing Address - Phone:301-258-1998
Mailing Address - Fax:
Practice Address - Street 1:656 QUINCE ORCHARD RD STE 104
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1423
Practice Address - Country:US
Practice Address - Phone:301-258-1998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty